Collective review of pancreatic carcinosarcoma, a very rare pancreatic malignancy

Abstract

Pancreatic carcinosarcoma is a very rare malignancy with a poor prognosis. Because of these characteristics, a treatment strategy for it has not been established yet. The aim of this study was to establish a therapeutic strategy for pancreatic carcinosarcoma. We reviewed data of a 65-year-old female patient who was diagnosed with pancreatic carcinosarcoma through endoscopic ultrasound-guided fine needle aspiration biopsy before surgery. For literature review, we searched PubMed using terms of "Pancreatic" or "Pancreas" and "carcinosarcoma" or "carcinosarcomatous". The patient received 11 cycles of neoadjuvant treatment with leucovorin, fluorouracil, irinotecan, oxaliplatin and pembrolizumab because the tumor was borderline resectable. She underwent stereotactic ablative body radiotherapy (SABR) with 35 Gy in 5 fractions, followed by robotic pylorus-preserving pancreaticoduodenectomy. After surgery, the patient received adjuvant chemotherapy in the same regimen as before surgery. She is alive without any recurrence. Among 48 patients within 33 available papers, the median survival time was 15 months. The survival rate of patients who received adjuvant chemotherapy tended to be higher than that of those who did not receive adjuvant chemotherapy, although the difference was not statistically significant (median survival, 47 vs. 15 months; p = 0.485). Three patients who received neoadjuvant chemotherapy had a survival period of 13-23.5 months. Surgery with lymphadenectomy, adjuvant therapy, and neoadjuvant therapy are thought to help improve survival outcomes. Modern treatment approaches for conventional pancreatic ductal adenocarcinoma could be applied to pancreatic carcinosarcoma.

Carcinosarcoma of pancreas: an unusual pancreatic tumour: case report

“…Modern treatment approaches for conventional pancreatic ductal adenocarcinoma could be applied to pancreatic carcinosarcoma. 9 Other potential second-line treatments include capecitabine or fluorouracil (5-FU), oxaliplatin with CAP or 5-FU, or gemcitabine with erlotinib. When comparing the overall survival, the use of second-line therapies shows a statistically significant increase compared with best supportive care.…”

Gastrointestinal: A cystic‐solid pancreatic mass: pancreatitis or adenocarcinoma?

“…The histopathological constitution of this case is rare, and the history of recurrent pancreatitis for 2 years made it more challenging to reach a malignant diagnosis before EUS‐FNA. Of note, carcinosarcoma can present with a cyst and necrosis on imaging findings 4 . Elevated CA19‐9 and SCCA levels are suggestive of malignancy.…”

“…Of note, carcinosarcoma can present with a cyst and necrosis on imaging findings. 4 The resected pathology of the pancreatic mass showed squamous carcinoma, adenocarcinoma, and sarcoma components (d). Immunohistochemistry showed the mass was positive for vimentin and CK5/6 (e,f).…”